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HomeMy WebLinkAbout026-1064-30-300 i Wisconsin sin i)� Count artment of Commerce PRIVATE SEWAGE SYSTEM St. Croix SaiDty and Building Division INSPECTION REPORT Sanitar Permit No: 499189 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Marek, Darin Richmond, Town of 026- 1064 -30 -300 CST BM Elev: Insp. BM Elev: / BM Description: Section/Town /Range /Map No: 1� q. vg G - 3 cs l 21.30.18.320C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark l.•J ' c fr +1-N 2 /Z 5o y�, Z-6 103,3 7'?, a V P� to k� 5 Z 5 Alt. Bfv]�'� CoU S, I 9 S . _Z-4 Aeration Bldg. Sewer 7,iZ 9�, �- Holding St/Ht Inlet 01 'j 5 , Z'7 TANK SETBACK INFORMATION St/Ht outlet y . Z5 I CIS TANK TO ff WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic N' i 5 d i Dt Bottom 2-1 Dosing Header /Man. 3 Aeration Dist. Pipe 9y 7 Holding Bot. System Sw /o, ICo nlora, 1 6 • z 9 3 • f y PUMP /SIPHON INFORMATION Final Grade 4/ 5-p. Manufacturer GPM St Cover l �` Cc s � Model Number TDH Lift Friction Loss System Hea 1 1�0 _ Ft Forcemain Lengt Dist. to Well _ J SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length No. Of Tren PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 92— SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: ^ L System I I ' INFORMATION CHAMBER OR I Z N/ 1 h Type Of Sy: r / ^ � UNIT Model Number: r G O��J�' �- /v I OJ i c!G 4 T DISTRIBUTION SYSTEM /tJ Z 1- z3 = 4 1(c L i! Distribution x Hole Size x Hole Spacing Vent to Air take Pipe(s) � Dia 1 4 length \ Dia \ Spacing \ \ e SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over I Depth Over j xx Depth of [77;;Te7odded xx Mulched Bed/Trench Center S, �� Bed /Trench Edges Topsoil Yes No Yes o COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: i / \ Location: 1439 112th Street New Richmond, WI 54017 (NE 1/4 SW 114 21 T30N R18W) NA Lot 3 Parcel No: 21.30.18.320C 1.) Alt BM Description 2.) Bldg sewer length = 7 - amount of cover Plan revision Required? Yes No \ C b' Use other side for additional information. \ Date Insepcto#ignatu Cert . No. SBO -6710 (R.3/97) A Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 t Ix vsconsin Madison, WI 53707 - 7162 be filled in by Co.) Department of Commerce (608) 266 -3151 99 $ Sanitary Permit Application State Pl I.D. Num In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 4 may be used for secondary purposes Privacy Law, s 15.04(1)(m) Project Address (if different than mailing address) I. Application Informati Please Print All Information 112th Street EECEIVED Property Owner's Name Par # t # Block # Darin Marek 3 Property Owner's Mailing Address SEP 2 Property Location 1306 210th Avenue NE SW City, State Zip C e o e um r V., '/y Section 21 New Richmond, WI 540 - T 30 N; R � circle IL Type of Building (check all that apply) s..li r^, rr o l I� / Q 1 or 2 Family Dwelling - Number of Bedrooms 4 Subdivision Name CSM Number �f.�� tMaty �- �� ( Public/Commercial - Describe Use M I �,((`,�„,, 4 1 s David RODS ❑ State Owned- Describe Use Z ��. - Ln1dLJ� /..Jf 2,2a -Z.3 OCity QVillage 0t ownship of Richmond III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Z( 1 ,6 (0'7 - 36 - A. ® New System y ©Replacement System ❑ Treatment/Holding Tank Replacement Only 13 Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner r IV. Type of POWTS System: Check all that appl ® Non - Pressurized In- Ground ❑ Mound > 24 in, of suitable soil 13 Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter Q Constructed Wetiand ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber 13 Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis rsal[Freatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area equired (sf) Dispersal Area oposed (sf) System El 600 ✓ 0.7 858 8711 J 93.73 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass �L New Existing r /1 /�/� 1 Tanks Tanks Septic or Holding Tank 1250 1200 1 Wieser x Aerobic Treanncut Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Mike Nelson — - ' m � ✓ ��- -- MP 225051 715- 273 -5000 Plumber's Address (Street, City, State, Zip Code) 278 East Summit Avenue Ellsworth, WI 54011 _ VVIHXCoun /De artment Use Onl Approved ❑ is ov Sanitary Permit Fee 'n udes Groundwater Da Issu Issuing ent Sign a tam Surcharge Fee)j\ en Reason for Denial �j(� (�(�/ IX. Conditions of Approval/Reasons for Disapproval \ n SYSTEM OWNER: 3 � � �nn� � � t` a✓� °td� ; � ,�rk 1. Septic tank, effluent finer and , dispersal cell must all be service / n 1 p s maintained as er management Ian provided b lumber. bdc� �d P. 9 P p YP . All setback r I c, 2 a requirements must be maintained` S , l t�J as per applicable code / ordinances. i Attaeh complete plans (to the County only) for the system on paper not than 81/2 x 11 inches in sine SBD -6398 (R. 01/03) (� 10/17/2006 13:45 FAX a 001 /001 Darin Marek r� 1306 2.1 A vemw NewRric"Mx4 WC 54017 AE %SW Y S21, 1'30N,R18 David Roes Lot # 3�' Richmond Towinhip _ St Croiur CaMurty Scale I" — 40' Weiser 1250 t=k. BM #1= 100.00' top of conduit pipe BM #2— 99.45' tap of conduit pipe System U 93.73' 45 Quick 4 chant"Ps • � Z ,C o ~ j LtJECL � � a 2 � 14 f n 1 S d 14G' E.4sT Z.-Y Bru► t �3r►'1 S Page 6 of 9 Darin Marek 1306 210' Avenue (" New Rrichmond, WI 54017 Ate. N NE <,SW %, S21, T30N, R 18 W 17,6• David Roos Lot # 3 Richmond Township St. Croix County Scale 1 "= 40' Weiser 1250 tank BM #1= 100.00' top of conduit pipe BM #2= 99.45' top of conduit pipe System EL 93.73' 45 Quick 4 chambers Ga rt ;C Q(jSd/7YN/ Ec, 9 0 O ;C O e VI B z � � fi 1 h 0 A. o n a- :X \ � 4 llhf 2 /3 /h ' Page 6 of 9 Darin Marek 1306 21 # Avenue New Rrichmond, WI 54017 ApP N NE Y,, SW Y,, S21 T30NR18W 176 � 1 David Roos Lot # 3 p "�r�•r Richmond Township St. Croix County Scale I" = 40' Weiser 1250 tank BM #1= 100.00' top of conduit pipe BM #2= 99.45' top of conduit pipe System EL 93.73' 45 Quick 4 chambers G4 it t y 1fc d�.o,� Ni+.ri �WEL� 4% Q4s rr„r r. t' V1 o Q e a o az ., Al c n n a. l 4G' iF4S? Page 6 of 9 F Wisconsin Department of Commerce SOIL EVALUATION REPORT pap 1 of 3 Division of Safety and Buildings itlf ce with Comm 86, Ws. Adm. Code county lete site an on i" St. Croix Attach complete plan paper not than 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and ho • reference point (BM), direction and Parcel I arce.D. p�� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please rant all information. Date P Personal information ou y provide may be or , s.15.04(l) (m)). 7q 16 Property Owner i Property Location David R s G NE 1/4 SW 1/4 S 21 T 30 N R 18 E (or)® ov Property Owner's Mailing Address M A I U ZUU4 Block # Subd. Name or CSM# I / 1912 Ford P rkway _ 3 Roos !/ city State zip ity []village ■ own Nearest Roe St. Paul AV 1 551 ZONING OFrICE 112th Street E] New Constriction UseEj Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement 0 Public or commercial - Describe: Parent material Loess over outwash Flood Plain elevation if applicable N ft . General comments �o Site suitable for a below grade conventional system N Q f and recommendation : it tv ;� s �- IF FTI Q pit Ground surface eiev. 101.15 ft. Depth to limiting factor 53-63 i Sal Appl aition Rabe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPQ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -11 10yr3 /3 sil 2msbk mfr as 2f .6 .8 r 2 11 -24 140jal 0 sil 2msbk mfr cw if .6 .8 3 2430 7.5yr4/4 - scl lmsbk mfr cw if 2 • 4 30-46 7.5yr4/4 is Om mfi cw - 17 1.6 5 46 -53 7.5yr5/4 sl lmsbk mfr cw - .2 .6 6 53-63 10yr5 /4 .WyO /a sicl lmsbk mfr cw - •2 • 7 63 -98 7.5yr6/6 1, J s Osg ml - - .7 6 ❑ 2 Boring # Boring � 98,E 39 -50 Q Pit Grou surface elev. __„� Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Texture Structure Consistence Boundary Roots GPDW In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 '092 1 0 -10 10yr3 /3 - sil 2msbk mfr as 2f .6 .8 2 10-18 1 3/6 - 3& sl 1 msbk mfr cw if .4 .6 3 18-39 7.5yr4/4 alop?.u• - is Osg mvfr cw _ .7 1.6 4 39 -50 7.5yr5/4 c2d5yr5 /8 sicl lmsbk mfr cw - 2 .3 5 50-90 7.5yr6/6 s Osg ml - - .7 1.6 E I ' Effluent #1 = BOD > 30 220 mg& and TSS >30 < 150 mgA- - D 1 30 mgA- and TSS < 30 mg1L. CST Name (Please Print) CST CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432120th Street, New Richmond, Wl 3/30/04 715- 246n2454 ^^ Pro 2 perty Owner Roos Parcel ID # Pending Page of 3 Boring ❑ # pit Ground surface elev. 99.08 X94 ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Efr#1 'Eff#2 1 0 -15 10yr3/3 - sil 2msbk mfr as 2f .6 .8 2 15 -27 l 3/6 - sil lmsbk mfr cw if .4 .6 3 10yr5 /4 - sil lmsbk mfr cw if 4 .6 4 44 -94 7.5yr6/6 - s Osg ml - - 7 1.6 r� Boring # Boring • Pit Ground surface elev. ft. Depth to limiting factor �G•✓ in. Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 •Eft#2 I 0-,,& ,o,IL a13 51 z 10 • -10 ro 5; t 161m. s l y F ng # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAY in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EB#1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 2648777. se13- 9330Test (R07/00) �. David Roos Lot 3 6e 1; 0--a- 36' I M L B1 ■ 1 51 B3 , go 114' M1 36' \ 102' 2 2 117' 180' 100 B2 scale 1" = 30' BM1 Top of conduit pipe 100.00' BM2 Top of conduit pipe 99.45 131 101.15' B2 98.90' B3 99.08' Thomas Nelson 227387 A'LPRGEENp1H GE 4842 REGISTER OF DEEDS 2 _ REIYED RECORD 09/29/2004 10:00AN ,,�Ap p - Ey CERTIFIED SURVEY NAP 1' = MAR I 4 2 EARINGS ARE REFERENCED TO THE REC FEE: 13.00 AST -WEST 1/4 LINE OF SECTION 21, COPY FEES 3.00 I / b SSUMED TO BEAR N89 °54 "E PAGESs 2 8's. C{r} :w C 1�iL aY CUL -DE -SAC o SlJf 1 irC 1( EASEMENT 1 12TH ST. NOT IMPROVED / VOL_13 PG_ 3717 !� a _ B EYOND CUL -DE -SAC _112 ST NOO °23'55 "W 1328.22' G _ 740.22' r 196.00' 196.00' Li 14 196.00' 740.36' r 196.00' 196.00' 195.72' EST LINE OF THE NE1 14 OF THE SW1 /4 L11 16 S00 °23'55 "E 1328.37 SETBACK ..................... .... . ....� R ............ zi m co z m N00'23'55"W 392.0 NO2'3645 "E 192.16' 1 i 1 1 � � 0' r rn Id � P. N � p 1 m i"ab l_ OA Am pm p y Iii Id YI m N N lA r r r r r r r r r r r r ►: i I� - $ i '� fQ -/ 1 D Ol CT A C2 N r y W C. Wi g $ 8a!i $ '8 � m N i D (� 8 �7 A 7 � bo �bs������fs;����fs;��o - r i '_"�O O m y y m m m T T T 1'1; m f7� Z ➢ I j' 1 a - n r � i2 8 IRi $i � w r w �' N m i m m m is M "-' I EAST LINE OF THE NE1 /4 OF THE SW1 14 i 500° 'S1 "E B23.22' i — LJNPLATTED LANDS i o to '*n O r- to V 1 m O r z o Z�6 Ov T vozcC 'o m c: m 1 G) A � — o z O� i, n Rf C�pc7m ym Z ' imo 2 v� C /v m°0v m �y me $mac O Zvcn l�tf �Oip 7 � g m _ zc �z o, < v Z� ?m cS erl m �' 25 v y y Oroo W Z Z Z 0 O y r�r m a � X O $ z O SHEET 1 OF 2 SHEETS Vol 19 Page 4842 ST. CROIX COUNTY .PTIC TAN P; MAM"nNANCE AGRL AND (11,V NFR. 1, 111P , �'ERT.TLC.�ATION 1:0RM Mailing,AddrCss 1`10per-ty Address j j1 04 A L Y/Stae Pill 1 dartH R ICation Munber e? Cv — I Progeny Loccatir 1 0 sec, N R _L V ( . )Ivn () f Subdivision Lat Certified Survey 4xp 9 Volunle L!I— Page # Warranty Deed Volume Page 9 SPOC house yes nc5 Lof bnes WnItlable •e3 no MSTM MM —N AND NJ) T CEV'rIVF9- A PVIr. TIOV"yPer uwe and rmbmttrance of 2,4.rz "T -q Y 5 t 4— !I C Mull 41 itsoremarme fmiln-v to 11andit) wastes, Prow r-WYjt=RA consists of P OUT tht Vpric. LPUj Ljery thre.t Yeats or t.tZiter, if ncodai:L by a licensed pump %,vh.,It y:;14 j i th# systern Can of the Function of the septic tack as a treatyrterff q%Age. Al the NAWTC IEgpt3$a� 5%.-S*OtFL Q C.r nA.jntl: - n X in §C qy I . 2j 3 j,, in G1, S C ro t) ( Ccv. SaWtary 0miliance. property o j igro _Qt. yq; eparrawrit a ce owner and bY 0 masftr plurabet juvArottyman pj r ('Oul)ry P corm, !r " LrLcted 0 Zuni 0 .1 z 1witbor or a Licv-n.Wd pj4mpar verifying till! (1) the 0, w9grew3tter disposal vstezr :s in proper q C . Our h- j 4II&Or ( after ingpectnor and piunping (Ir IcsS Hiatt ;i3 fill 45IL14C. tj ept i Fvw, the. undersigned have read the above requilytriont4, s a,d agree: toumitital I The prNow. sowage dis"al.eystL-al w,rlt th standards set forth. herein, 43 beL by Lbr. DenaMakm o and foe oqm. rm, ­; ir-'elroificatic)n stating th , our Mp A ajit QfNarmral Rp.qvurves, State t'-- s t b" becil maia�ed ijual be u,?yjpjete.d %Aid 7—tumed te.N the st p & Zaaiag Department within 3 () d o f ft duce yexr expiration data. Croix C oun t } lazitzing I cg'ttifY that all star.enwim on this foyn, are trite to the best ofmy,() k—u proptrry & above, , S -Mcdge . uvvc alward the 0 Umelf 01 Fate VAtU. 04 warranty dvr4l rtcq it, Rovifiwr 0 Deeda Offtce:. :Number Of bedrooms SIGNATURE DATE uy In �Mris is re s e nted my result ir, t."' ""tary r ,c,lnl t br * V-1-OkO by tile Piwitarig 3t mooing L)epartanent b-irkide wit this aPplication a recorded wa Mty 4, front OW Register 0"DW& im.d a cnspy arVLw cei%ifled siv :f rclerouce is made iij dw warranty cietA (RFV. alms) Td WdFS:20 9002 2-E! 2269-917E—SU '0N XHJ A36JW I ?JIJ(I 4108A I Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shalt be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when I removed from its enclosure. If the fitter is equippedwith an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank, If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Page I of 7 Distribution System No trees or shrubs should be planted on the septic system. Plantings may be made around the septic system's perimeter, and the septic system shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the septic system is not recommended since soil compaction may hinder aeration of the infiltrative surface within the septic system and snow compaction in the winter will promote frost penetration. Cold weather, installations (October- February) dictate that the septic system be heavily mulched for frost protection. Influent quality into the septic system may not exceed 220 mg /L 8005, 150 mg/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in acxmrdance with Comm 82 -84 Wis. Adm.'Code, and shall maintained in accordance with its' component manual [SBD- 10705- P(N.01 /01)] and local or state rules pertaining to system maintenance and maintenance reporting. a No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS oomponents. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Continge cy Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the septic system component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area If toe leakage occurs or by removing biologically dogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: County Zoning Office 715 - 386 -4680 Mike Nelson Plumbing 715 - 273 -5000 Weiser Concrete 800- 325 -8456 Zabel Filter 800 -221 -5742 Page 7 of 8 Septic system plans For Darin Marek Lot # 3 David Roos NE /4,SW /4 Richmond Township St. Croix County Wisconsin Prepared by Mike Nelson Plumbing 278 E. Summit Ave. Ellsworth, WI 54011 273 -5000 MP# 225053 Page 1 Title sheet Page 2 -4 Soil evaluation report Page 5 System sizing Page 6 Plot plan Page 7 Management plan Page 8 Quick 4 Cross section Page 1 of 8 09/22/06 FRI 10:43 FAX 715 386 4686 Q001 Waconsin Department ofCommetas SOIL EVALUATION REPORT Papa 1 of 3 Division of Sa" and BuR*W with Corm► 85, Wit. Adm. Code P & I hm � sc. Croix Attach complete of plan on paper root 2 x 11 inches in size. Plan must hcluds, but rot Irritsd to. kel arms Point (BM). diragon and Panel I.D. p�jp percent ala fw, style or dgr►errtiorts, north arrow, and location and dhts►oa to nearest road. PIM" P" an Inftmemm. P*--d t 4M -abon ym PrWift nW be , 4, 15.04 (1) (M) ). Property Ow ter - - ..,... _... _ Property l O *Oon • David s GOKk NE 114 SW 114 S 21 T 30 N R 18 E era Property Dwr+efs Melling Address # Block 0 Subd. Name or CSW (� 1912 Ford P ay . 3 Roos f city star, zip N, I DNilape own Nearest 1� St. Paul N 1 551 Z NING OFFICE 112t) $Shv t E) Nee► Construction Uwril the . Rakientiel I Number of bedrooms 3 to 4 Code derfiwd design flow rate 450 to 600 GPD ❑ Replacement Public or aomnardal - Describe: Parent rrratWW Loess over outwash Flood Ptah+ elevation If appiicaWs N_ _ tt. end isoan aiion8 „ , �" r1 Site suitable for a below grads conventional system tIAL /- ��^'� (� Boring 0 0 owing Q Pit Ground surfeos slev. 101.15 ft. Depth to Imilrtp 3"63 - Y (--. 2, f 1 Sol Amicsfion Rats Morison Depth Dominant Redox Descripion Texbue Shudure Corrwaum ca Boundary Roofs ht. Muntes Qu. Sz. Cons Color Gr. Sz. Sh. •Ew 'E1a12 1 0-11 10yr3/3 - sit 2msbk mfr as 2f .6 .8 2 11 -24 3 r sil 2msbk mfr cw If .6 .8 3 24-30 7.Syt4/4 scl lmsbk mfr cw 1f .2 . 4 30.46 7.5yr4/4 Is 0m mfl cw - 1.6 5 46-53 7.5yr5/4 - sl imsbk mfr cw - 2 6 6 53-63 10yr5 /4 c2d5yr5/8 sici l mtbk mfr cw - .2 .3 7 63-98 7.5yr6/6 s Oag ml - - 7 1.6 E E �e a e Bones - / C 7 1 98.E 39 -50 ❑ Pit sumacs elev. _ .� Depth to kniU g factor in. Soil Application Rap tiorim DeM Dominant Color Redw Ted ure Struc twe Consistence Bourdsry Roots GPOW in. Munsell am St. Cont. Color Gr. Sz. Sh. •Ethyl `E1fd2 1 0.10 10yr3 /3 - sil 2msbk mfr as 2f .6 .8 2 10-18 1 /6B sl lmsbk mfr cw If .4 .6 3 18-39 7.5yr4/4 Q4du' 0sg mv¢ cw _ 7 1.6 4 39-50 7.5yrY4 cZdSyrsJB sial Imsbk mfr ew - .2 .3 5 50-90 7.5yt6/6 �/ s 089 m1 - - .7 1.6 ' Emuent 41 = BOD > 30 220 mwt and TSS >30 150 ag l- < 30 nrgll. and TSS 5 30 mgrs CST Puma (PMess Print) CST Number Thomas C Nelson 227387 Addre s Dale Evekstlon Conducted Telephone Number 1432 120th Strxt, New Richmmd, W1 3/30/04 715 -246 -2454 09/22/06 FRI 10:44 FAX 715 386 4686 @002 ProPsetf► Offm Ro Pane! DO pe Paps 2 of 3 EE [9 pit Ground awftw obv. 0$ R DOOM to lins" fi :br >94 IA. 0 &gL=dw Rafe tiatimn Dep>h Oor irwt Color Re0aet Dasa"m Taftm Shch n C.ontisonos eour4wy Roots GPOR in. MuteM Qu. SL Cant Color Gr. Sz. $h. OM I OEM 1 0-15 1Oye" - sil 2msbk mfx as 2f 6 .8 2 15-27 10w3/6 - ail ltuabk mfr Cw if .4 .6 3 10yr5 /4 _ gill imrbk mfr ew if 4 .6 4 444 1 7.5yr&6 - s �g Ml - - 7 1.6 r, JXO •� Ptt Ground oma" alw. _„_ ft. Depth to Ovdi nil looker in. Rats Haimn Depth Dominant Color Deeaip m Tax6Ae SMUdtae CWWWM nee gamdary Rook OPOdf in, Mu sell Qu. Sz. Cont. Color Gr. Sz. Sh. 'F�1 •81M2 I I I F-1 Pit � Ground surfaceobv. n Dapf:► b Hmitlrg taGor in. Soil AxAbdon Rao Mortma Deptlt Dm* wt Color Recker Dow "on Toe" Si ud" Camitiwwa 8otatdary Root OM in. Miawil Qu. Ss Cart color Gr. SL Sh. 'EA1 • Edsr' ' 01 - MOO s 30= 220 nrplL and TSS . s 160 nV L ' Mm t dQ - 9M:j 30 rnWL and TSS :j 30 njOL TLe Department of Commerce is an equal opportunity sery ice provider and employer. If you need assistsom to seem services or weed material in ao abonwe forms% plegse aoaoet die department at 60i -266 -3151 or TTY 608 - 264-5777. s904uarMOL0740) 09/22/06 FRI 10:44 FAX 715 386 4686 Q003 David Roos Lot 3 lx � 3s B1 � � 15 B3 114' 13M 36' 49L 2' slope BM2 117' �'— 180' 100' B2 "0 1"= 30' BMl To of conduit pipe 100.09 P PP BM2 Top of conduit pipe 99.45' B1 101.15' B2 98.90' B3 99.08' Thames Nelson 227387 Sizing for a 4 bedroom house Weiser 1250 Septic tank Zabel A 1800 filter System Elevation 93.73' 4 bedrooms x 150 gpd = 600 gpd 600 gpd / 0.7 = 857.14 sq. ft. 2 sets of Quik 4 end caps a@ 5.8 = 11.6 sq. ft. 857.14 — 11.6 = 845.54 sq. ft. 845.54 / 19.1 = 44.26 45 Quick 4 Chambers Page 5 of 8 #ffA i ck4 nw — IgF STANDARD CHAMBER 52' Quick4 Standard Chamber 4e• (EFFECTIVE LENGTH) E3 12" 6" 34" SIDE VIEW SECTION VIEW MultiPort End Cap R 12' 1s• — 34• SIDE VIEW TOP VIEW FRONT VIEW INFILTRATOR SYSTEMS INC STANDARD LjmITEn WARRANTY W Tne stnrcr hbgrsy «each awnbw and pwo. wasps aid Pair soceswry rrrwtWcysp by Ytgret« ( 9LNb�, wnsn hw all and cpsr"d h a leeasl9ltl a an arbks SWW aywem h socMWb with In Nratota hesxriorrs, b warafed b a" «qrw purcfbssr CMarer1 ageaet debcNe M e t I a s ph worlanwtwNp br Or" ysw Nom ate dee vw C" sefxtc Pemst b blued br ab ssPNO oalbhhg tlw t1ri1& provkbd, trowevw. atal q a sep4c pwmlt rqt m"W by appecabie law, Me wwm* Pwbd vA begin upon Ere deb aat jrei ion a a" m ptic system mrrerrwroaa. To w wcm Ns wwrwsy rytas, Hader xw now womw h %vwv a sa Oorp«eb fbadgcwbrs h 010 SwAm,. Corcbcflax w fs"wt 1151 roorag" etegeo derau. tt ator wi atPPN mPbcam m U0s for W Urxts dwamf!"d by hNNrator b Oe oawred by tHS UnNlstl w u , . i sPedaceNY exdxles aw Doer of rwnover wxY« N aswtlan of ab tXSb. 71iE LIMIiW WAl NN1Yn OAB ARE DOal131vE Tf191E ARE ti0OTN9i WnRRAMIiE $ O " r�N� ."r�`�t��"�'""'�N""�R��R " N be v TO rHE M SYSTEMS INC rbt .> *W oid enY Of ft cfta WOW b mre+ba,aad by any«,. eatw Nran t ..or ma Ur. VNartwNy does txodxct on ana PraMS boor en ff"ww. rre �"pBO tow o wp w w k l was t P Ho «wWdwed aemeges. ha,drg toes a &MfMl1911t81 Onsfte W"te"W Solutlofe extruded rran tJrrtNed mste, « ortwr toaeae «aupbea Ncurad by me Hotda «try ado P" SpedF ate txsts; dte L►tl"b �aW ara damage to a" twets owe to «1*11" war ens raw, wwraaon, somw% rrspas, sixes or nsabat of to ^ ew #e , °'°'w WOO" " O*A ° a r a PWm h WbySoknow°" ,mm so �wo 6 Business Park Road • P.O. BOX 768 vw units or a e aepac syetan sue to �cfty t are paoanrwa a snP cM Rwwiab kW the vAtem awa*ft we drab; bare a any other eaM rot cased by Li�ribd Yyar"*M be M w 4M to b�0"vw a�na awom. «haopw xpwanxn: « Old Saybrook, CT 06475 wwrauy. w4h aN d the tams aw brat h d>ia LeriNeo 860- 577 -7000 " FAX 860- 577 -7001 Fura"r. h no evax ehet e"Itrst« be reaPw"Cb br eM lose «dwnegs IO ate Molder Ihs L#*o, or"11NW P" reolav f«n hwswoWrf or W*. reN. «:.w""°°a ,�, �� ;,„ h 800 -221-4436 nW rsPre e a "W h" the 4&" b awrga «wdaa ws tjnwd wanrNy, Mo wertwey VPW [0 MW Wly ahw fan ne miw T1" eba'e m Wema to Pc r of t.Wts eha I anbaa sawed by tn11{rstot A YNbd ni nbsr of sWIN and corxebt twa dMwrt wwranty noxys. mama. NMSa«h CaPOrw NrdWwtwe h Oro Ssybodc. Cktrn dW. Prior atxir copy a tins sPPirabYS warapy, w4 *"Ad cw4* rand trot wararsy prior to as prsawa of L►tits. Prscetsse. w cook a Canadian Patents 1.329,989 2.004.584 00w patenLy prl U.S. Patents: 4,759,881; 5,017,041; 5,156,488; 5,338,017; 5,401.118,5,401,459; 5,511,903:5.716,183; 5,588,778; 5,838,844 ndkV. Ir6VaUx. Ecitmam and Sid*Ander ere ropfstered haownwM of WAValor Sgsbnq a Inc. IrMlLrat« b Systems Inc. is a registered bademrk in Mexico. Contou , Concar SYrIvel C«etectlm. Berea baowerk in Rance. Wave r and fApdc4 are ttaderrlarlty of 1nNtrator Srstema h_ a wvnv r,.rxr.dr... _PalyTiAt, SnapLOdc, Pik C ckCut. ouidcPlav aecrccio n wEn ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A 1, /'t C k Mailing Address G 4 '�2 Z � 14 ye-" �_ 4 or Property Address N 31 I 2 (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number 2 — G G y - ?O ~' 306 LEGAL DESCRIPTION Property Location '/4 , '/4 , Sec. , T 3'e N R/ F_ W, Town of Subdivision _�a �, ,1 o a s , Lot # . Certified Survey Map # , Volume °( , Page # L4 'R� Warranty Deed # �� S / `G� , Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms `7 I S GNATURE OF APPLICANTS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) =ROM :DARIN -MAREK FAX NO. :715- 246 -6933 Sep. 25 2006 08:26AM P1 se - - -- -- _ -- ;. 99 ,Z3 ....... _..- ..._..: : F g Ti i s 1'9 i 67 ....__. e',a _. .a 3 o m — - -- 131 - I "'-- -• 9'11 - 'to I i _ ti � 2•4 f 3 — -a _- t ;n ... 'v 118 • ' m t i za g 8...-- Ito i r { ff l I G ..,....178 _...... 42'6 • .. . -17.' � .. -._... _ -. g f � T I � j c►rer 27 Wk* , I w,-w -M:r 2I w�0e 1NL ;iU %*-mtt 26 j I I i I Mtlt� 33 ' t t` r t I 3.4 2%0sq it Hal -ROM : DAR I N -MAREK FAX NO. :715-246-69 Sep. 25 2006 08: 35AM P1 V 29 ..._.,___� �__ _.__..__....__._........ N ez „�zeou � I of wv I i eALK (Z Sir I � + I I _ Gn LY �— Fa 1 i f � � w 1 ......ld._,... a N - - - .tl J i � S j 1 I t 1, N ti s Lw UU4 e C; ' T? 3 562 484�2 RFn> 3TlR OR D@BDl; is sr. asffl 2M4 IA � MM MAQ 14 1. EAA�S ARE REFERENCED TO THE , SWvsr NAP �` � 3. T -WEST 114 LINE OF SECTION 21, Cory FE6t 3. N kSSUUED TO BEAR N89'S4'36 - F PAOBB 3 Z S'f. Ci{{i'X Lau,%qy CUL 06 -SAC SLR VtY�}!Yfi RF�CRD EMENT r a.� { 12TH ST. NOT IMWiO� V�ir o � `� I.Z�-± Y_ 1 7 - 17 a ( — e FYOM CUL -DE-SAC _ 11LT _H_�Z' N04'23'SS'YII 132822' $ 740.38' Si •88.00 19x.00 165.72 ST UN6 OF THE NEt /4 OF THE SW 1K S 900'23'55"E 132a.3F L11 e $ ............................ ....... ..... ........ ..S€Tencx . ® NA= ~ $S f N00'2755 w 392.0Cr NO2'36'45'S 162.1x' ' is ts 3 t . m ► ] jp�j y 3i iD i � .T y - i -i H i 1 ' - !- •- � � -r ' r � fri v si �i � �o .�a r � � I� �' m ' E l l yA R f EAST UNE OF THE NEw4 of THE swim j spa• •ai-E 1 23 s�• i - � _ z fn* 'o" o a 3i �' C ' /y - d SHEET I OF 2 SHEETS Vol 19 Page- 4842 X3 83s 1 �rz, KATHLEEN H. WALSH State Bar of Wisconsin Form 1 -2003 REGISTER OF DEEDS ST. CROI?t GO., M1I WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 09/25/2006 10 :10AH WARRANTY DEED EXDPT 11 THIS DEED, made between Robert A. Peterson, Robert W. Peterson, and Michael J. Driscoll REC FEE: 13.00 ( "Grantor," whether one or more), TRANS FEE: 153.00 and Darin H. Marek and Ololade 0, Marek COPY FEE: , h isband and wi CC FEE: PAGES: 2 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed, please attach addendum): River Valley Abstract &Title, Inc. 1200 Hosford Street, Suite 201 SEE ATTACHED Hudson, WI 54016 File #: 2691294 026 - 1064 -30 -300 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights -of -way of record, if any. Dated September 22, 2006 -� (SEAL) (SEAL) * Robert A. Peterson * Robert W. Peterson T (SEAL) (SEAL) * * Michael J. Driscili AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) �, ) ss. authenticated on St. Croix COUNTY ) o tC7r y 4r * j Personally came before me on September 22, 2006 , TITLE: MEMBER STATE B �jSCONSIN the above -named Robert A. Peterson, Robert W. Peterson and (If not, "�/7 Michael J. Driscoll authorized by Wis. Stet. § 706.06) a known to � e person(s) who executed the foregoing in 7T)n le e THIS INSTRUMENT DRAFTED BY: * Attorney Doug Berg 1200 Hosford Street, Suite 201 Hudson, WI 54016 Co lic, ate a Wisconsin 'sslon (is permanent) (expires: (Signatures may be authenticated or aclmowiedged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 • Type name below signatures. a Legal Description Part of NE 1/4 of the SW 1/4 of Section 21, Township 30 North, Range 18 West, St. Croix County, Wisconsin described as follows: Lot 3 of Certified Survey Map filed September 29, 2004 in Volume 19, Page 4842 as Document No. 775562. Together With the Joint Driveway Easement as shown on Certified Survey Map in Volume 19, Page 4842 as Document No. 775562. HsLEc a /96